title: Low-pressure pneumoperitoneum during laparoscopic donor nephrectomy to optimize live donors' comfort.
abstract: Nowadays, laparoscopic donor nephrectomy (LDN) has become the gold standard to procure live donor kidneys. As the relationship between donor and recipient loosens, it becomes of even greater importance to optimize safety and comfort of the surgical procedure. Low-pressure pneumoperitoneum has been shown to reduce pain scores after laparoscopic cholecystectomy. Live kidney donors may also benefit from the use of low pressure during LDN. To evaluate feasibility and efficacy to reduce post-operative pain, we performed a randomized blinded study. Twenty donors were randomly assigned to standard (14 mmHg) or low (7 mmHg) pressure during LDN. One conversion from low to standard pressure was indicated by protocol due to lack of progression. Intention-to-treat analysis showed that low pressure resulted in a significantly longer skin-to-skin time (149 ± 86 vs. 111 ± 19 min), higher urine output during pneumoperitoneum (23 ± 35 vs. 11 ± 20 mL/h), lower cumulative overall pain score after 72 h (9.4 ± 3.2 vs. 13.5 ± 4.5), lower deep intra-abdominal pain score (11 ± 3.3 vs. 7.5 ± 3.1), and a lower cumulative overall referred pain score (1.8 ± 1.9 vs. 4.2 ± 3). Donor serum creatinine levels, complications, and quality of life dimensions were not significantly different. Our data show that low-pressure pneumoperitoneum during LDN is feasible and may contribute to increase live donors' comfort during the early post-operative phase.
authors.affiliation: Division of Vascular- and Transplant Surgery, Department of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. M.Warle@chir.umcn.nl
authors.forename: M C
authors.initials: MC
authors.lastname: Warlé
authors.forename: A W
authors.initials: AW
authors.lastname: Berkers
authors.forename: J F
authors.initials: JF
authors.lastname: Langenhuijsen
authors.forename: M F
authors.initials: MF
authors.lastname: van der Jagt
authors.forename: Ph M
authors.initials: PM
authors.lastname: Dooper
authors.forename: H J
authors.initials: HJ
authors.lastname: Kloke
authors.forename: D
authors.initials: D
authors.lastname: Pilzecker
authors.forename: S H
authors.initials: SH
authors.lastname: Renes
authors.forename: K E
authors.initials: KE
authors.lastname: Wever
authors.forename: A J
authors.initials: AJ
authors.lastname: Hoitsma
authors.forename: J A
authors.initials: JA
authors.lastname: van der Vliet
authors.forename: F C H
authors.initials: FC
authors.lastname: D'Ancona
mesh_terms: D004311:Double-Blind Method; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000592:standards*; D007902:Length of Stay; D019520:Living Donors / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000592:standards*; D010149:Postoperative Pain / Q000517:prevention & control*; D010865:Pilot Projects; D011027:Pneumoperitoneum; D011379:Prognosis; D059039:Standard of Care; D020858:Tissue and Organ Harvesting / Q000592:standards*
keywords: laparoscopic donor nephrectomy; low pressure; pneumoperitoneum; post-operative pain